Test Obstacles

A recommendation for routine HIV testing is going unheeded.

THE FEAR and stigma surrounding HIV and AIDS make it difficult to persuade people to get tested. A series of studies presented at a conference in Arlington last month showed that clinicians and insurance companies also are obstacles to the care and counseling needed to prolong lives and protect the uninfected. As a result, far too many cases of HIV infection go undiagnosed and untreated.

The Centers for Disease Control and Prevention recommended in 2006 that people age 13 to 64 receive routine HIV testing, with an opt-out provision for those who don't want to be tested. But the guidance is going unheeded. Many medical workers find it too time-consuming to provide routine testing in doctors' offices and emergency rooms. As if that weren't bad enough, some insurers are balking at paying for the tests. Time and money certainly are precious, but they shouldn't be more valuable than trying to save lives.

AIDS has killed more than 25 million people around the world since 1981. It has devastated communities across the United States, particularly in urban centers. The District of Columbia has been especially hard hit. While there are 14 cases of AIDS per 100,000 people in the United States, the rate is a staggering 128 cases per 100,000 here, according to the 2007 District of Columbia HIV/AIDS Epidemiology Annual Report. The city is pushing to make HIV testing part of routine care. But as we now know, that's not a guarantee of action.

What's needed is focus and a little more financial and political oomph at the federal level. An excellent idea to get this done was presented in a Post op-ed piece last month by Robert C. Gallo, one of the scientists who uncovered HIV as the cause of AIDS. Recognizing the great success of the President's Emergency Plan for AIDS Relief (PEPFAR), the initiative that President Bush launched for Africa, Dr. Gallo called on President-elect Barack Obama to create a PEPFAR for America's inner cities. Mr. Bush's initiative has provided antiretroviral treatment for more than 1.7 million people around the world since 2003. Imagine what PEPFAR could accomplish at home.